Daisymm
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Looking for coding assistance for a total distal femur replacement procedure:
PREOPERATIVE DIAGNOSIS: Left distal femur fracture.
POSTOPERATIVE DIAGNOSIS: Left distal femur fracture.
PROCEDURE PERFORMED: Left total distal femur replacement.
ANESTHESIA: General with femoral nerve block.
ESTIMATED BLOOD LOSS: 200 cc.
IMPLANTS: Zimmer distal femur replacement size D with 11 mm x 130 mm stem extension, NexGen rotating hip, knee, tibial component size 3 non-modular Trabecular Metal stem collar 25 mm outer diameter, Zimmer articular surface with hinged post size D 17 mm
height.
INDICATION: The patient is a 94-year-old female with a history of longstanding end-stage degenerative changes of the left knee who sustained a mechanical fall at home. she
sustained a comminuted fracture of her distal femur. She was initially treated with a Bledsoe brace, but continued to have significant pain and Orthopedics was reconsulted for consideration of surgical intervention. Considering the amount of
degenerative changes, required surgery would be a distal femur replacement. Given the patient's age and comorbidities, a long discussion was had with the patient and family regarding the risks and benefits of surgery. After explaining these risks in
detail, the family and patient chose for surgical intervention and she was subsequently optimized by Medicine, Cardiology, and Renal prior to surgery.
PROCEDURE: The patient was seen in the holding area by both the orthopedic and anesthesia teams. The patient's left knee was clearly marked by the attending surgeon. Informed consent was then reviewed with the patient. She was taken to the operating
room and placed supine on the operating room table. A time-out was performed as per hospital protocol confirming correct patient, correct procedure, and correct side. General anesthesia was carried out and a femoral regional block was placed
preoperatively. The patient was given prophylactic antibiotics. The left lower extremity was prepped and draped in a sterile fashion. The leg was elevated and a thigh tourniquet was inflated to 275 mmHg.
A 12 cm midline incision was made, carried down through the skin and soft tissue. A medial patellar arthrotomy was performed and the prepatellar fat pad was excised. Examination revealed comminuted fracture involving articular surface of distal femur.
Initial focus was on the femur and using an oscillating saw, a transverse cut was placed approximately 9 cm above the joint line across the femoral shaft. Using a combination of osteotome and Bovie electrocautery, the remnants of the distal femur were
excised.
Attention was then focused on the tibia. Using an extramedullary guide, we excised approximately 2 mm of bone off of the more deficient medial plateau. We then placed the tibial trial ensuring proper rotation between the medial and middle thirds of the
tibial tubercle. We then focused back on the distal femur. We began reaming the distal femur up to a size 13. The distal femur placement was size D after the cut. We then placed the femoral trial and then an articular spacer was placed. The knee was
reduced. We were able to get full extension and approximately 120 degrees of flexion. At this point, we inspected the patella. Given the thinness of the patella, we decided not to resurface. We then removed the trial components and copiously
irrigated the knee. We then inserted the final tibial component cementing the augment to the tibial plate. We had good fixation distally. Curettes were used to remove any excess cement.
Attention was then focused on the femur. We cleaned out the femoral canal and placed a cement restrictor. We then thoroughly dried prior to the preparation of cement. We then used pressured cement and inserted the distal femur component with good
fixation. We allowed the cement to cure and cleaned off any excess cement with curettes. We then placed a final 17 mm articular surface and was secured this with a locking pin which was tightened with a torque wrench. We then copiously irrigated the
knee and closed the arthrotomy with Stratafix barbed suture reinforced with #0 Vicryl. The deep dermal layer was closed with #2-0 Vicryl and the skin layer was closed with staples. A sterile dressing was then placed. The patient was returned back into
the Bledsoe brace locked in extension. The patient was awoken from anesthesia and transferred to the post anesthesia care unit in stable condition.
PREOPERATIVE DIAGNOSIS: Left distal femur fracture.
POSTOPERATIVE DIAGNOSIS: Left distal femur fracture.
PROCEDURE PERFORMED: Left total distal femur replacement.
ANESTHESIA: General with femoral nerve block.
ESTIMATED BLOOD LOSS: 200 cc.
IMPLANTS: Zimmer distal femur replacement size D with 11 mm x 130 mm stem extension, NexGen rotating hip, knee, tibial component size 3 non-modular Trabecular Metal stem collar 25 mm outer diameter, Zimmer articular surface with hinged post size D 17 mm
height.
INDICATION: The patient is a 94-year-old female with a history of longstanding end-stage degenerative changes of the left knee who sustained a mechanical fall at home. she
sustained a comminuted fracture of her distal femur. She was initially treated with a Bledsoe brace, but continued to have significant pain and Orthopedics was reconsulted for consideration of surgical intervention. Considering the amount of
degenerative changes, required surgery would be a distal femur replacement. Given the patient's age and comorbidities, a long discussion was had with the patient and family regarding the risks and benefits of surgery. After explaining these risks in
detail, the family and patient chose for surgical intervention and she was subsequently optimized by Medicine, Cardiology, and Renal prior to surgery.
PROCEDURE: The patient was seen in the holding area by both the orthopedic and anesthesia teams. The patient's left knee was clearly marked by the attending surgeon. Informed consent was then reviewed with the patient. She was taken to the operating
room and placed supine on the operating room table. A time-out was performed as per hospital protocol confirming correct patient, correct procedure, and correct side. General anesthesia was carried out and a femoral regional block was placed
preoperatively. The patient was given prophylactic antibiotics. The left lower extremity was prepped and draped in a sterile fashion. The leg was elevated and a thigh tourniquet was inflated to 275 mmHg.
A 12 cm midline incision was made, carried down through the skin and soft tissue. A medial patellar arthrotomy was performed and the prepatellar fat pad was excised. Examination revealed comminuted fracture involving articular surface of distal femur.
Initial focus was on the femur and using an oscillating saw, a transverse cut was placed approximately 9 cm above the joint line across the femoral shaft. Using a combination of osteotome and Bovie electrocautery, the remnants of the distal femur were
excised.
Attention was then focused on the tibia. Using an extramedullary guide, we excised approximately 2 mm of bone off of the more deficient medial plateau. We then placed the tibial trial ensuring proper rotation between the medial and middle thirds of the
tibial tubercle. We then focused back on the distal femur. We began reaming the distal femur up to a size 13. The distal femur placement was size D after the cut. We then placed the femoral trial and then an articular spacer was placed. The knee was
reduced. We were able to get full extension and approximately 120 degrees of flexion. At this point, we inspected the patella. Given the thinness of the patella, we decided not to resurface. We then removed the trial components and copiously
irrigated the knee. We then inserted the final tibial component cementing the augment to the tibial plate. We had good fixation distally. Curettes were used to remove any excess cement.
Attention was then focused on the femur. We cleaned out the femoral canal and placed a cement restrictor. We then thoroughly dried prior to the preparation of cement. We then used pressured cement and inserted the distal femur component with good
fixation. We allowed the cement to cure and cleaned off any excess cement with curettes. We then placed a final 17 mm articular surface and was secured this with a locking pin which was tightened with a torque wrench. We then copiously irrigated the
knee and closed the arthrotomy with Stratafix barbed suture reinforced with #0 Vicryl. The deep dermal layer was closed with #2-0 Vicryl and the skin layer was closed with staples. A sterile dressing was then placed. The patient was returned back into
the Bledsoe brace locked in extension. The patient was awoken from anesthesia and transferred to the post anesthesia care unit in stable condition.